Is BMI greater than 50 kgm 2 a predictor of higher morbidity during doing laparoscopic sleeve gastrectomy an Observational Study at King Khalid University Hospital Saudi Arabian experience

Supervisor Dr Fahad Yaslam Bamehriz

Yara Abdullah Alanazi

Rawan Fawaz Alotaibi

Nawt Mohammd Alfuweres

Najla Musaed Alsaikhan

Waad Bader Almanie

Munira Khalifa Alghafaily F4

HEADLINES

Introduction

bull Research question

bull Objectives and Hypothesis

bull Method

bull Results

bull Conclusion

bull Recommendation

bull Acknowledgement

bull References

Introduction and rationale

1 Obesity is a major health issue that is increasing instantly worldwide the prevalence of super morbid obesity is increasing among the world population

2 The bariatric surgery has been established as the most effective long-term treatment for morbid obesity

3 Super morbid obese [body mass index (BMI)thinspgtthinsp50 kgm2] carries high morbiditymortality risks to patients and during doing their bariatric surgery

Introduction and rationale

4 Few studies with small numbers in the English medical literatures has reported the morbiditymortality of super morbid obese patients during performing laparoscopic sleeve gastrectomy

5 The purpose of this study was to assess operative and post-operative complications of laparoscopic sleeve gastrectomy in super-obese and compare it to morbid obese on in King Khalid University Hospital Saudi Arabia

RESEARCH QUESTION

Does Super obese patients (BMI ge50 kgm2) prone to develop more operative and post-operative complications than morbidly obese during and following laparoscopic sleeve gastrectomy

Objectives

1 To document the complications related to BMI ge50 kgm2of the patient who underwent laparoscopic sleeve gastrectomy in KKUH And compare the rate of these to obese underwent laparoscopic sleeve gastrectomy surgery in KKUH and then to international report 2 To determine if BMI ge50 kgm2 is a predictor of higher morbidity after laparoscopic sleeve gastrectomy

Methodology

Design

Observational analytic retrospective cohort

study Sampling method

Random Sampling

Data collecting toolspatients

medical records retrospectively

Data Analysis and ManagementSPSS

Inclusion exclusion BMIgt50 gt16

Settingking khalid

university hospital 2009

to 2015

Size

708 patients

217 SMO

491 MO

Methodology

Result

Out Of 708 patients performing LSG their 217 (31) patients with BMI ge 50 with comparable BMI (583plusmn72 kgm2 for SMO (BMI ge 50) group vs 419 plusmn47 kgm2 for MO (BMI lt 50) group P lt 00001)

MO

N= 490

SMO

N= 217

P-value

Age meanplusmnSD 3346plusmn107 3221plusmn11 0155

Height meanplusmnSD 16plusmn0096 165plusmn0007 0500

Admission weight meanplusmnSD 1141plusmn192 15940plusmn265 P lt 00001

Admission BMI meanplusmnSD 419plusmn47 5827plusmn719 P lt 00001

3700

6360

6300

3640

000 1000 2000 3000 4000 5000 6000 7000

BMI lt 50

BMI equal 50 or more

Female Male

Result

MO

N= 491

SMO

N= 217

P-value

Hypertension n () 67 (136) 36 (166) 0306

Diabetes mellitus n () 68 (138) 29(134) 0863

Dyslipidemia n () 38 (77) 24 (111) 0150

Sleep apnea n () 69 (141) 48 (212) 0017

Infertility n () 6 (12) 2 (09) 0535

1360 1380

770

1410

120

1660

1340

1110

2120

090

000

500

1000

1500

2000

2500

Hypertension Diabetes mellitus Dyslipidemia Sleep apnea Infertility

MO SMO

Result

MO

BMI lt 50 group

SMO

BMI ge 50 group

P-value

Duration of operation meanplusmnSD 9064plusmn383 9274plusmn35 053

Number of trocars meanplusmnSD 460plusmn723 430plusmn068 056

length of stay meanplusmnSD 373plusmn254 447plusmn318 0003

Recovery room time meanplusmnSD 8439plusmn2828 8763plusmn2911 0301

HDU admission n () 32 (65) 62 (286) P lt 00001

There is no significant difference in the duration of operation length of stay Number of trocars and Recovery room time between the two groups

LSG was performed successfully in all patients and no conversion to open or documented intraoperative complications in both groups

Result

MO

BMI lt 50 group(21)

SMO

BMI ge 50 group(13)

P-value

Blood transfusion n () 4 (08) 0 (0) 0230

Early leak n () 4 (08) 1 (05) 0515

Late leak n () 7 (14) 2 (09) 0445

Post operative bleeding n () 10 (2) 10 (46) 0057

4

96

MO

With Postoperative complications

no Postoperative complications

6

94

SMO

With Postoperative complications

no Postoperative complications

Conclusion

To sum up therersquos no significant difference in the duration of operation number of trocars and

intra operative complication between SMO and MO The BMI ge50 is not a predictor of higher morbidity during doing laparoscopic sleeve

gastrectomy at King Khalid University Hospital Saudi Arabian experience

Acknowledgment

bull Special thanks to DrFahad Bamehriz who was guiding and supporting us in every step of the research

bull Also we would like to thank MissSara ALhezan from obesity center faculty for their valuable time

Reference

1 Sturm R Hattori A Morbid obesity rates continue to rise rapidly in the United States Int J Obes (Lond) 2013 Jun37(6)889-91

2 Serrano O Tannebaum J Cumella L Choi J Vemulapalli P Scott Melvin W et al Weight loss outcomes and complications from bariatric surgery in the super super obese Surgical Endoscopy 2015

3 Zerrweck C Sepuacutelveda E Maydoacuten H Campos F Spaventa A Pratti V et al Laparoscopic Gastric Bypass vs Sleeve Gastrectomy in the Super Obese Patient Early Outcomes of an Observational Study Obesity Surgery 201324(5)712-717

4 Kushnir L Dunnican W Benedetto B Wang W Dolce C Lopez S et al Is BMI greater than 60 kgm2 a predictor of higher morbidity after laparoscopic Roux-en-Y gastric bypass Surgical Endoscopy 200924(1)94-97

5 Lemanu D Srinivasa S Singh P MacCormick A Ulmer S Morrow J et al Single-stage laparoscopic sleeve gastrectomy safety and efficacy in the super-obese Journal of Surgical Research 2012177(1)49-54

6 Serrano OK1 Tannebaum JE Cumella L Choi J Vemulapalli P Scott Melvin W et al Weight loss outcomes and complications from bariatric surgery in the super super obese Surg Endosc 2015 Aug 25

7 Tagaya N1 Kasama K Kikkawa R Kanahira E Umezawa A Oshiro T et al Experience with laparoscopic sleeve gastrectomy for morbid versus super morbid obesity Obes Surg 2009 Oct19(10)1371-6

8 Zerrweck C1 Sepuacutelveda EM Maydoacuten HG Campos F Spaventa AG Pratti V et al Laparoscopic gastric bypass vs sleeve gastrectomy in the super obese patient early outcomes of anobservational study Obes Surg 2014 May24(5)712-7

9 Eisenberg D1 Bellatorre A Bellatorre N Sleeve gastrectomy as a stand-alone bariatric operation for severe morbid and super obesity JSLS 2013 Jan-Mar17(1)63-7

HEADLINES

Introduction

bull Research question

bull Objectives and Hypothesis

bull Method

bull Results

bull Conclusion

bull Recommendation

bull Acknowledgement

bull References

Introduction and rationale

1 Obesity is a major health issue that is increasing instantly worldwide the prevalence of super morbid obesity is increasing among the world population

2 The bariatric surgery has been established as the most effective long-term treatment for morbid obesity

3 Super morbid obese [body mass index (BMI)thinspgtthinsp50 kgm2] carries high morbiditymortality risks to patients and during doing their bariatric surgery

Introduction and rationale

4 Few studies with small numbers in the English medical literatures has reported the morbiditymortality of super morbid obese patients during performing laparoscopic sleeve gastrectomy

5 The purpose of this study was to assess operative and post-operative complications of laparoscopic sleeve gastrectomy in super-obese and compare it to morbid obese on in King Khalid University Hospital Saudi Arabia

RESEARCH QUESTION

Does Super obese patients (BMI ge50 kgm2) prone to develop more operative and post-operative complications than morbidly obese during and following laparoscopic sleeve gastrectomy

Objectives

1 To document the complications related to BMI ge50 kgm2of the patient who underwent laparoscopic sleeve gastrectomy in KKUH And compare the rate of these to obese underwent laparoscopic sleeve gastrectomy surgery in KKUH and then to international report 2 To determine if BMI ge50 kgm2 is a predictor of higher morbidity after laparoscopic sleeve gastrectomy

Methodology

Design

Observational analytic retrospective cohort

study Sampling method

Random Sampling

Data collecting toolspatients

medical records retrospectively

Data Analysis and ManagementSPSS

Inclusion exclusion BMIgt50 gt16

Settingking khalid

university hospital 2009

to 2015

Size

708 patients

217 SMO

491 MO

Methodology

Result

Out Of 708 patients performing LSG their 217 (31) patients with BMI ge 50 with comparable BMI (583plusmn72 kgm2 for SMO (BMI ge 50) group vs 419 plusmn47 kgm2 for MO (BMI lt 50) group P lt 00001)

MO

N= 490

SMO

N= 217

P-value

Age meanplusmnSD 3346plusmn107 3221plusmn11 0155

Height meanplusmnSD 16plusmn0096 165plusmn0007 0500

Admission weight meanplusmnSD 1141plusmn192 15940plusmn265 P lt 00001

Admission BMI meanplusmnSD 419plusmn47 5827plusmn719 P lt 00001

3700

6360

6300

3640

000 1000 2000 3000 4000 5000 6000 7000

BMI lt 50

BMI equal 50 or more

Female Male

Result

MO

N= 491

SMO

N= 217

P-value

Hypertension n () 67 (136) 36 (166) 0306

Diabetes mellitus n () 68 (138) 29(134) 0863

Dyslipidemia n () 38 (77) 24 (111) 0150

Sleep apnea n () 69 (141) 48 (212) 0017

Infertility n () 6 (12) 2 (09) 0535

1360 1380

770

1410

120

1660

1340

1110

2120

090

000

500

1000

1500

2000

2500

Hypertension Diabetes mellitus Dyslipidemia Sleep apnea Infertility

MO SMO

Result

MO

BMI lt 50 group

SMO

BMI ge 50 group

P-value

Duration of operation meanplusmnSD 9064plusmn383 9274plusmn35 053

Number of trocars meanplusmnSD 460plusmn723 430plusmn068 056

length of stay meanplusmnSD 373plusmn254 447plusmn318 0003

Recovery room time meanplusmnSD 8439plusmn2828 8763plusmn2911 0301

HDU admission n () 32 (65) 62 (286) P lt 00001

There is no significant difference in the duration of operation length of stay Number of trocars and Recovery room time between the two groups

LSG was performed successfully in all patients and no conversion to open or documented intraoperative complications in both groups

Result

MO

BMI lt 50 group(21)

SMO

BMI ge 50 group(13)

P-value

Blood transfusion n () 4 (08) 0 (0) 0230

Early leak n () 4 (08) 1 (05) 0515

Late leak n () 7 (14) 2 (09) 0445

Post operative bleeding n () 10 (2) 10 (46) 0057

4

96

MO

With Postoperative complications

no Postoperative complications

6

94

SMO

With Postoperative complications

no Postoperative complications

Conclusion

To sum up therersquos no significant difference in the duration of operation number of trocars and

intra operative complication between SMO and MO The BMI ge50 is not a predictor of higher morbidity during doing laparoscopic sleeve

gastrectomy at King Khalid University Hospital Saudi Arabian experience

Acknowledgment

bull Special thanks to DrFahad Bamehriz who was guiding and supporting us in every step of the research

bull Also we would like to thank MissSara ALhezan from obesity center faculty for their valuable time

Reference

1 Sturm R Hattori A Morbid obesity rates continue to rise rapidly in the United States Int J Obes (Lond) 2013 Jun37(6)889-91

2 Serrano O Tannebaum J Cumella L Choi J Vemulapalli P Scott Melvin W et al Weight loss outcomes and complications from bariatric surgery in the super super obese Surgical Endoscopy 2015

3 Zerrweck C Sepuacutelveda E Maydoacuten H Campos F Spaventa A Pratti V et al Laparoscopic Gastric Bypass vs Sleeve Gastrectomy in the Super Obese Patient Early Outcomes of an Observational Study Obesity Surgery 201324(5)712-717

4 Kushnir L Dunnican W Benedetto B Wang W Dolce C Lopez S et al Is BMI greater than 60 kgm2 a predictor of higher morbidity after laparoscopic Roux-en-Y gastric bypass Surgical Endoscopy 200924(1)94-97

5 Lemanu D Srinivasa S Singh P MacCormick A Ulmer S Morrow J et al Single-stage laparoscopic sleeve gastrectomy safety and efficacy in the super-obese Journal of Surgical Research 2012177(1)49-54

6 Serrano OK1 Tannebaum JE Cumella L Choi J Vemulapalli P Scott Melvin W et al Weight loss outcomes and complications from bariatric surgery in the super super obese Surg Endosc 2015 Aug 25

7 Tagaya N1 Kasama K Kikkawa R Kanahira E Umezawa A Oshiro T et al Experience with laparoscopic sleeve gastrectomy for morbid versus super morbid obesity Obes Surg 2009 Oct19(10)1371-6

8 Zerrweck C1 Sepuacutelveda EM Maydoacuten HG Campos F Spaventa AG Pratti V et al Laparoscopic gastric bypass vs sleeve gastrectomy in the super obese patient early outcomes of anobservational study Obes Surg 2014 May24(5)712-7

9 Eisenberg D1 Bellatorre A Bellatorre N Sleeve gastrectomy as a stand-alone bariatric operation for severe morbid and super obesity JSLS 2013 Jan-Mar17(1)63-7

Introduction and rationale

1 Obesity is a major health issue that is increasing instantly worldwide the prevalence of super morbid obesity is increasing among the world population

2 The bariatric surgery has been established as the most effective long-term treatment for morbid obesity

3 Super morbid obese [body mass index (BMI)thinspgtthinsp50 kgm2] carries high morbiditymortality risks to patients and during doing their bariatric surgery

Introduction and rationale

4 Few studies with small numbers in the English medical literatures has reported the morbiditymortality of super morbid obese patients during performing laparoscopic sleeve gastrectomy

5 The purpose of this study was to assess operative and post-operative complications of laparoscopic sleeve gastrectomy in super-obese and compare it to morbid obese on in King Khalid University Hospital Saudi Arabia

RESEARCH QUESTION

Does Super obese patients (BMI ge50 kgm2) prone to develop more operative and post-operative complications than morbidly obese during and following laparoscopic sleeve gastrectomy

Objectives

1 To document the complications related to BMI ge50 kgm2of the patient who underwent laparoscopic sleeve gastrectomy in KKUH And compare the rate of these to obese underwent laparoscopic sleeve gastrectomy surgery in KKUH and then to international report 2 To determine if BMI ge50 kgm2 is a predictor of higher morbidity after laparoscopic sleeve gastrectomy

Methodology

Design

Observational analytic retrospective cohort

study Sampling method

Random Sampling

Data collecting toolspatients

medical records retrospectively

Data Analysis and ManagementSPSS

Inclusion exclusion BMIgt50 gt16

Settingking khalid

university hospital 2009

to 2015

Size

708 patients

217 SMO

491 MO

Methodology

Result

Out Of 708 patients performing LSG their 217 (31) patients with BMI ge 50 with comparable BMI (583plusmn72 kgm2 for SMO (BMI ge 50) group vs 419 plusmn47 kgm2 for MO (BMI lt 50) group P lt 00001)

MO

N= 490

SMO

N= 217

P-value

Age meanplusmnSD 3346plusmn107 3221plusmn11 0155

Height meanplusmnSD 16plusmn0096 165plusmn0007 0500

Admission weight meanplusmnSD 1141plusmn192 15940plusmn265 P lt 00001

Admission BMI meanplusmnSD 419plusmn47 5827plusmn719 P lt 00001

3700

6360

6300

3640

000 1000 2000 3000 4000 5000 6000 7000

BMI lt 50

BMI equal 50 or more

Female Male

Result

MO

N= 491

SMO

N= 217

P-value

Hypertension n () 67 (136) 36 (166) 0306

Diabetes mellitus n () 68 (138) 29(134) 0863

Dyslipidemia n () 38 (77) 24 (111) 0150

Sleep apnea n () 69 (141) 48 (212) 0017

Infertility n () 6 (12) 2 (09) 0535

1360 1380

770

1410

120

1660

1340

1110

2120

090

000

500

1000

1500

2000

2500

Hypertension Diabetes mellitus Dyslipidemia Sleep apnea Infertility

MO SMO

Result

MO

BMI lt 50 group

SMO

BMI ge 50 group

P-value

Duration of operation meanplusmnSD 9064plusmn383 9274plusmn35 053

Number of trocars meanplusmnSD 460plusmn723 430plusmn068 056

length of stay meanplusmnSD 373plusmn254 447plusmn318 0003

Recovery room time meanplusmnSD 8439plusmn2828 8763plusmn2911 0301

HDU admission n () 32 (65) 62 (286) P lt 00001

There is no significant difference in the duration of operation length of stay Number of trocars and Recovery room time between the two groups

LSG was performed successfully in all patients and no conversion to open or documented intraoperative complications in both groups

Result

MO

BMI lt 50 group(21)

SMO

BMI ge 50 group(13)

P-value

Blood transfusion n () 4 (08) 0 (0) 0230

Early leak n () 4 (08) 1 (05) 0515

Late leak n () 7 (14) 2 (09) 0445

Post operative bleeding n () 10 (2) 10 (46) 0057

4

96

MO

With Postoperative complications

no Postoperative complications

6

94

SMO

With Postoperative complications

no Postoperative complications

Conclusion

To sum up therersquos no significant difference in the duration of operation number of trocars and

intra operative complication between SMO and MO The BMI ge50 is not a predictor of higher morbidity during doing laparoscopic sleeve

gastrectomy at King Khalid University Hospital Saudi Arabian experience

Acknowledgment

bull Special thanks to DrFahad Bamehriz who was guiding and supporting us in every step of the research

bull Also we would like to thank MissSara ALhezan from obesity center faculty for their valuable time

Reference

1 Sturm R Hattori A Morbid obesity rates continue to rise rapidly in the United States Int J Obes (Lond) 2013 Jun37(6)889-91

2 Serrano O Tannebaum J Cumella L Choi J Vemulapalli P Scott Melvin W et al Weight loss outcomes and complications from bariatric surgery in the super super obese Surgical Endoscopy 2015

3 Zerrweck C Sepuacutelveda E Maydoacuten H Campos F Spaventa A Pratti V et al Laparoscopic Gastric Bypass vs Sleeve Gastrectomy in the Super Obese Patient Early Outcomes of an Observational Study Obesity Surgery 201324(5)712-717

4 Kushnir L Dunnican W Benedetto B Wang W Dolce C Lopez S et al Is BMI greater than 60 kgm2 a predictor of higher morbidity after laparoscopic Roux-en-Y gastric bypass Surgical Endoscopy 200924(1)94-97

5 Lemanu D Srinivasa S Singh P MacCormick A Ulmer S Morrow J et al Single-stage laparoscopic sleeve gastrectomy safety and efficacy in the super-obese Journal of Surgical Research 2012177(1)49-54

6 Serrano OK1 Tannebaum JE Cumella L Choi J Vemulapalli P Scott Melvin W et al Weight loss outcomes and complications from bariatric surgery in the super super obese Surg Endosc 2015 Aug 25

7 Tagaya N1 Kasama K Kikkawa R Kanahira E Umezawa A Oshiro T et al Experience with laparoscopic sleeve gastrectomy for morbid versus super morbid obesity Obes Surg 2009 Oct19(10)1371-6

8 Zerrweck C1 Sepuacutelveda EM Maydoacuten HG Campos F Spaventa AG Pratti V et al Laparoscopic gastric bypass vs sleeve gastrectomy in the super obese patient early outcomes of anobservational study Obes Surg 2014 May24(5)712-7

9 Eisenberg D1 Bellatorre A Bellatorre N Sleeve gastrectomy as a stand-alone bariatric operation for severe morbid and super obesity JSLS 2013 Jan-Mar17(1)63-7

Introduction and rationale

4 Few studies with small numbers in the English medical literatures has reported the morbiditymortality of super morbid obese patients during performing laparoscopic sleeve gastrectomy

5 The purpose of this study was to assess operative and post-operative complications of laparoscopic sleeve gastrectomy in super-obese and compare it to morbid obese on in King Khalid University Hospital Saudi Arabia

RESEARCH QUESTION

Does Super obese patients (BMI ge50 kgm2) prone to develop more operative and post-operative complications than morbidly obese during and following laparoscopic sleeve gastrectomy

Objectives

1 To document the complications related to BMI ge50 kgm2of the patient who underwent laparoscopic sleeve gastrectomy in KKUH And compare the rate of these to obese underwent laparoscopic sleeve gastrectomy surgery in KKUH and then to international report 2 To determine if BMI ge50 kgm2 is a predictor of higher morbidity after laparoscopic sleeve gastrectomy

Methodology

Design

Observational analytic retrospective cohort

study Sampling method

Random Sampling

Data collecting toolspatients

medical records retrospectively

Data Analysis and ManagementSPSS

Inclusion exclusion BMIgt50 gt16

Settingking khalid

university hospital 2009

to 2015

Size

708 patients

217 SMO

491 MO

Methodology

Result

Out Of 708 patients performing LSG their 217 (31) patients with BMI ge 50 with comparable BMI (583plusmn72 kgm2 for SMO (BMI ge 50) group vs 419 plusmn47 kgm2 for MO (BMI lt 50) group P lt 00001)

MO

N= 490

SMO

N= 217

P-value

Age meanplusmnSD 3346plusmn107 3221plusmn11 0155

Height meanplusmnSD 16plusmn0096 165plusmn0007 0500

Admission weight meanplusmnSD 1141plusmn192 15940plusmn265 P lt 00001

Admission BMI meanplusmnSD 419plusmn47 5827plusmn719 P lt 00001

3700

6360

6300

3640

000 1000 2000 3000 4000 5000 6000 7000

BMI lt 50

BMI equal 50 or more

Female Male

Result

MO

N= 491

SMO

N= 217

P-value

Hypertension n () 67 (136) 36 (166) 0306

Diabetes mellitus n () 68 (138) 29(134) 0863

Dyslipidemia n () 38 (77) 24 (111) 0150

Sleep apnea n () 69 (141) 48 (212) 0017

Infertility n () 6 (12) 2 (09) 0535

1360 1380

770

1410

120

1660

1340

1110

2120

090

000

500

1000

1500

2000

2500

Hypertension Diabetes mellitus Dyslipidemia Sleep apnea Infertility

MO SMO

Result

MO

BMI lt 50 group

SMO

BMI ge 50 group

P-value

Duration of operation meanplusmnSD 9064plusmn383 9274plusmn35 053

Number of trocars meanplusmnSD 460plusmn723 430plusmn068 056

length of stay meanplusmnSD 373plusmn254 447plusmn318 0003

Recovery room time meanplusmnSD 8439plusmn2828 8763plusmn2911 0301

HDU admission n () 32 (65) 62 (286) P lt 00001

There is no significant difference in the duration of operation length of stay Number of trocars and Recovery room time between the two groups

LSG was performed successfully in all patients and no conversion to open or documented intraoperative complications in both groups

Result

MO

BMI lt 50 group(21)

SMO

BMI ge 50 group(13)

P-value

Blood transfusion n () 4 (08) 0 (0) 0230

Early leak n () 4 (08) 1 (05) 0515

Late leak n () 7 (14) 2 (09) 0445

Post operative bleeding n () 10 (2) 10 (46) 0057

4

96

MO

With Postoperative complications

no Postoperative complications

6

94

SMO

With Postoperative complications

no Postoperative complications

Conclusion

To sum up therersquos no significant difference in the duration of operation number of trocars and

intra operative complication between SMO and MO The BMI ge50 is not a predictor of higher morbidity during doing laparoscopic sleeve

gastrectomy at King Khalid University Hospital Saudi Arabian experience

Acknowledgment

bull Special thanks to DrFahad Bamehriz who was guiding and supporting us in every step of the research

bull Also we would like to thank MissSara ALhezan from obesity center faculty for their valuable time

Reference

1 Sturm R Hattori A Morbid obesity rates continue to rise rapidly in the United States Int J Obes (Lond) 2013 Jun37(6)889-91

2 Serrano O Tannebaum J Cumella L Choi J Vemulapalli P Scott Melvin W et al Weight loss outcomes and complications from bariatric surgery in the super super obese Surgical Endoscopy 2015

3 Zerrweck C Sepuacutelveda E Maydoacuten H Campos F Spaventa A Pratti V et al Laparoscopic Gastric Bypass vs Sleeve Gastrectomy in the Super Obese Patient Early Outcomes of an Observational Study Obesity Surgery 201324(5)712-717

4 Kushnir L Dunnican W Benedetto B Wang W Dolce C Lopez S et al Is BMI greater than 60 kgm2 a predictor of higher morbidity after laparoscopic Roux-en-Y gastric bypass Surgical Endoscopy 200924(1)94-97

5 Lemanu D Srinivasa S Singh P MacCormick A Ulmer S Morrow J et al Single-stage laparoscopic sleeve gastrectomy safety and efficacy in the super-obese Journal of Surgical Research 2012177(1)49-54

6 Serrano OK1 Tannebaum JE Cumella L Choi J Vemulapalli P Scott Melvin W et al Weight loss outcomes and complications from bariatric surgery in the super super obese Surg Endosc 2015 Aug 25

7 Tagaya N1 Kasama K Kikkawa R Kanahira E Umezawa A Oshiro T et al Experience with laparoscopic sleeve gastrectomy for morbid versus super morbid obesity Obes Surg 2009 Oct19(10)1371-6

8 Zerrweck C1 Sepuacutelveda EM Maydoacuten HG Campos F Spaventa AG Pratti V et al Laparoscopic gastric bypass vs sleeve gastrectomy in the super obese patient early outcomes of anobservational study Obes Surg 2014 May24(5)712-7

9 Eisenberg D1 Bellatorre A Bellatorre N Sleeve gastrectomy as a stand-alone bariatric operation for severe morbid and super obesity JSLS 2013 Jan-Mar17(1)63-7

RESEARCH QUESTION

Does Super obese patients (BMI ge50 kgm2) prone to develop more operative and post-operative complications than morbidly obese during and following laparoscopic sleeve gastrectomy

Objectives

1 To document the complications related to BMI ge50 kgm2of the patient who underwent laparoscopic sleeve gastrectomy in KKUH And compare the rate of these to obese underwent laparoscopic sleeve gastrectomy surgery in KKUH and then to international report 2 To determine if BMI ge50 kgm2 is a predictor of higher morbidity after laparoscopic sleeve gastrectomy

Methodology

Design

Observational analytic retrospective cohort

study Sampling method

Random Sampling

Data collecting toolspatients

medical records retrospectively

Data Analysis and ManagementSPSS

Inclusion exclusion BMIgt50 gt16

Settingking khalid

university hospital 2009

to 2015

Size

708 patients

217 SMO

491 MO

Methodology

Result

Out Of 708 patients performing LSG their 217 (31) patients with BMI ge 50 with comparable BMI (583plusmn72 kgm2 for SMO (BMI ge 50) group vs 419 plusmn47 kgm2 for MO (BMI lt 50) group P lt 00001)

MO

N= 490

SMO

N= 217

P-value

Age meanplusmnSD 3346plusmn107 3221plusmn11 0155

Height meanplusmnSD 16plusmn0096 165plusmn0007 0500

Admission weight meanplusmnSD 1141plusmn192 15940plusmn265 P lt 00001

Admission BMI meanplusmnSD 419plusmn47 5827plusmn719 P lt 00001

3700

6360

6300

3640

000 1000 2000 3000 4000 5000 6000 7000

BMI lt 50

BMI equal 50 or more

Female Male

Result

MO

N= 491

SMO

N= 217

P-value

Hypertension n () 67 (136) 36 (166) 0306

Diabetes mellitus n () 68 (138) 29(134) 0863

Dyslipidemia n () 38 (77) 24 (111) 0150

Sleep apnea n () 69 (141) 48 (212) 0017

Infertility n () 6 (12) 2 (09) 0535

1360 1380

770

1410

120

1660

1340

1110

2120

090

000

500

1000

1500

2000

2500

Hypertension Diabetes mellitus Dyslipidemia Sleep apnea Infertility

MO SMO

Result

MO

BMI lt 50 group

SMO

BMI ge 50 group

P-value

Duration of operation meanplusmnSD 9064plusmn383 9274plusmn35 053

Number of trocars meanplusmnSD 460plusmn723 430plusmn068 056

length of stay meanplusmnSD 373plusmn254 447plusmn318 0003

Recovery room time meanplusmnSD 8439plusmn2828 8763plusmn2911 0301

HDU admission n () 32 (65) 62 (286) P lt 00001

There is no significant difference in the duration of operation length of stay Number of trocars and Recovery room time between the two groups

LSG was performed successfully in all patients and no conversion to open or documented intraoperative complications in both groups

Result

MO

BMI lt 50 group(21)

SMO

BMI ge 50 group(13)

P-value

Blood transfusion n () 4 (08) 0 (0) 0230

Early leak n () 4 (08) 1 (05) 0515

Late leak n () 7 (14) 2 (09) 0445

Post operative bleeding n () 10 (2) 10 (46) 0057

4

96

MO

With Postoperative complications

no Postoperative complications

6

94

SMO

With Postoperative complications

no Postoperative complications

Conclusion

To sum up therersquos no significant difference in the duration of operation number of trocars and

intra operative complication between SMO and MO The BMI ge50 is not a predictor of higher morbidity during doing laparoscopic sleeve

gastrectomy at King Khalid University Hospital Saudi Arabian experience

Acknowledgment

bull Special thanks to DrFahad Bamehriz who was guiding and supporting us in every step of the research

bull Also we would like to thank MissSara ALhezan from obesity center faculty for their valuable time

Reference

1 Sturm R Hattori A Morbid obesity rates continue to rise rapidly in the United States Int J Obes (Lond) 2013 Jun37(6)889-91

2 Serrano O Tannebaum J Cumella L Choi J Vemulapalli P Scott Melvin W et al Weight loss outcomes and complications from bariatric surgery in the super super obese Surgical Endoscopy 2015

3 Zerrweck C Sepuacutelveda E Maydoacuten H Campos F Spaventa A Pratti V et al Laparoscopic Gastric Bypass vs Sleeve Gastrectomy in the Super Obese Patient Early Outcomes of an Observational Study Obesity Surgery 201324(5)712-717

4 Kushnir L Dunnican W Benedetto B Wang W Dolce C Lopez S et al Is BMI greater than 60 kgm2 a predictor of higher morbidity after laparoscopic Roux-en-Y gastric bypass Surgical Endoscopy 200924(1)94-97

5 Lemanu D Srinivasa S Singh P MacCormick A Ulmer S Morrow J et al Single-stage laparoscopic sleeve gastrectomy safety and efficacy in the super-obese Journal of Surgical Research 2012177(1)49-54

6 Serrano OK1 Tannebaum JE Cumella L Choi J Vemulapalli P Scott Melvin W et al Weight loss outcomes and complications from bariatric surgery in the super super obese Surg Endosc 2015 Aug 25

7 Tagaya N1 Kasama K Kikkawa R Kanahira E Umezawa A Oshiro T et al Experience with laparoscopic sleeve gastrectomy for morbid versus super morbid obesity Obes Surg 2009 Oct19(10)1371-6

8 Zerrweck C1 Sepuacutelveda EM Maydoacuten HG Campos F Spaventa AG Pratti V et al Laparoscopic gastric bypass vs sleeve gastrectomy in the super obese patient early outcomes of anobservational study Obes Surg 2014 May24(5)712-7

9 Eisenberg D1 Bellatorre A Bellatorre N Sleeve gastrectomy as a stand-alone bariatric operation for severe morbid and super obesity JSLS 2013 Jan-Mar17(1)63-7

Objectives

1 To document the complications related to BMI ge50 kgm2of the patient who underwent laparoscopic sleeve gastrectomy in KKUH And compare the rate of these to obese underwent laparoscopic sleeve gastrectomy surgery in KKUH and then to international report 2 To determine if BMI ge50 kgm2 is a predictor of higher morbidity after laparoscopic sleeve gastrectomy

Methodology

Design

Observational analytic retrospective cohort

study Sampling method

Random Sampling

Data collecting toolspatients

medical records retrospectively

Data Analysis and ManagementSPSS

Inclusion exclusion BMIgt50 gt16

Settingking khalid

university hospital 2009

to 2015

Size

708 patients

217 SMO

491 MO

Methodology

Result

Out Of 708 patients performing LSG their 217 (31) patients with BMI ge 50 with comparable BMI (583plusmn72 kgm2 for SMO (BMI ge 50) group vs 419 plusmn47 kgm2 for MO (BMI lt 50) group P lt 00001)

MO

N= 490

SMO

N= 217

P-value

Age meanplusmnSD 3346plusmn107 3221plusmn11 0155

Height meanplusmnSD 16plusmn0096 165plusmn0007 0500

Admission weight meanplusmnSD 1141plusmn192 15940plusmn265 P lt 00001

Admission BMI meanplusmnSD 419plusmn47 5827plusmn719 P lt 00001

3700

6360

6300

3640

000 1000 2000 3000 4000 5000 6000 7000

BMI lt 50

BMI equal 50 or more

Female Male

Result

MO

N= 491

SMO

N= 217

P-value

Hypertension n () 67 (136) 36 (166) 0306

Diabetes mellitus n () 68 (138) 29(134) 0863

Dyslipidemia n () 38 (77) 24 (111) 0150

Sleep apnea n () 69 (141) 48 (212) 0017

Infertility n () 6 (12) 2 (09) 0535

1360 1380

770

1410

120

1660

1340

1110

2120

090

000

500

1000

1500

2000

2500

Hypertension Diabetes mellitus Dyslipidemia Sleep apnea Infertility

MO SMO

Result

MO

BMI lt 50 group

SMO

BMI ge 50 group

P-value

Duration of operation meanplusmnSD 9064plusmn383 9274plusmn35 053

Number of trocars meanplusmnSD 460plusmn723 430plusmn068 056

length of stay meanplusmnSD 373plusmn254 447plusmn318 0003

Recovery room time meanplusmnSD 8439plusmn2828 8763plusmn2911 0301

HDU admission n () 32 (65) 62 (286) P lt 00001

There is no significant difference in the duration of operation length of stay Number of trocars and Recovery room time between the two groups

LSG was performed successfully in all patients and no conversion to open or documented intraoperative complications in both groups

Result

MO

BMI lt 50 group(21)

SMO

BMI ge 50 group(13)

P-value

Blood transfusion n () 4 (08) 0 (0) 0230

Early leak n () 4 (08) 1 (05) 0515

Late leak n () 7 (14) 2 (09) 0445

Post operative bleeding n () 10 (2) 10 (46) 0057

4

96

MO

With Postoperative complications

no Postoperative complications

6

94

SMO

With Postoperative complications

no Postoperative complications

Conclusion

To sum up therersquos no significant difference in the duration of operation number of trocars and

intra operative complication between SMO and MO The BMI ge50 is not a predictor of higher morbidity during doing laparoscopic sleeve

gastrectomy at King Khalid University Hospital Saudi Arabian experience

Acknowledgment

bull Special thanks to DrFahad Bamehriz who was guiding and supporting us in every step of the research

bull Also we would like to thank MissSara ALhezan from obesity center faculty for their valuable time

Reference

1 Sturm R Hattori A Morbid obesity rates continue to rise rapidly in the United States Int J Obes (Lond) 2013 Jun37(6)889-91

2 Serrano O Tannebaum J Cumella L Choi J Vemulapalli P Scott Melvin W et al Weight loss outcomes and complications from bariatric surgery in the super super obese Surgical Endoscopy 2015

3 Zerrweck C Sepuacutelveda E Maydoacuten H Campos F Spaventa A Pratti V et al Laparoscopic Gastric Bypass vs Sleeve Gastrectomy in the Super Obese Patient Early Outcomes of an Observational Study Obesity Surgery 201324(5)712-717

4 Kushnir L Dunnican W Benedetto B Wang W Dolce C Lopez S et al Is BMI greater than 60 kgm2 a predictor of higher morbidity after laparoscopic Roux-en-Y gastric bypass Surgical Endoscopy 200924(1)94-97

5 Lemanu D Srinivasa S Singh P MacCormick A Ulmer S Morrow J et al Single-stage laparoscopic sleeve gastrectomy safety and efficacy in the super-obese Journal of Surgical Research 2012177(1)49-54

6 Serrano OK1 Tannebaum JE Cumella L Choi J Vemulapalli P Scott Melvin W et al Weight loss outcomes and complications from bariatric surgery in the super super obese Surg Endosc 2015 Aug 25

7 Tagaya N1 Kasama K Kikkawa R Kanahira E Umezawa A Oshiro T et al Experience with laparoscopic sleeve gastrectomy for morbid versus super morbid obesity Obes Surg 2009 Oct19(10)1371-6

8 Zerrweck C1 Sepuacutelveda EM Maydoacuten HG Campos F Spaventa AG Pratti V et al Laparoscopic gastric bypass vs sleeve gastrectomy in the super obese patient early outcomes of anobservational study Obes Surg 2014 May24(5)712-7

9 Eisenberg D1 Bellatorre A Bellatorre N Sleeve gastrectomy as a stand-alone bariatric operation for severe morbid and super obesity JSLS 2013 Jan-Mar17(1)63-7

Methodology

Design

Observational analytic retrospective cohort

study Sampling method

Random Sampling

Data collecting toolspatients

medical records retrospectively

Data Analysis and ManagementSPSS

Inclusion exclusion BMIgt50 gt16

Settingking khalid

university hospital 2009

to 2015

Size

708 patients

217 SMO

491 MO

Methodology

Result

Out Of 708 patients performing LSG their 217 (31) patients with BMI ge 50 with comparable BMI (583plusmn72 kgm2 for SMO (BMI ge 50) group vs 419 plusmn47 kgm2 for MO (BMI lt 50) group P lt 00001)

MO

N= 490

SMO

N= 217

P-value

Age meanplusmnSD 3346plusmn107 3221plusmn11 0155

Height meanplusmnSD 16plusmn0096 165plusmn0007 0500

Admission weight meanplusmnSD 1141plusmn192 15940plusmn265 P lt 00001

Admission BMI meanplusmnSD 419plusmn47 5827plusmn719 P lt 00001

3700

6360

6300

3640

000 1000 2000 3000 4000 5000 6000 7000

BMI lt 50

BMI equal 50 or more

Female Male

Result

MO

N= 491

SMO

N= 217

P-value

Hypertension n () 67 (136) 36 (166) 0306

Diabetes mellitus n () 68 (138) 29(134) 0863

Dyslipidemia n () 38 (77) 24 (111) 0150

Sleep apnea n () 69 (141) 48 (212) 0017

Infertility n () 6 (12) 2 (09) 0535

1360 1380

770

1410

120

1660

1340

1110

2120

090

000

500

1000

1500

2000

2500

Hypertension Diabetes mellitus Dyslipidemia Sleep apnea Infertility

MO SMO

Result

MO

BMI lt 50 group

SMO

BMI ge 50 group

P-value

Duration of operation meanplusmnSD 9064plusmn383 9274plusmn35 053

Number of trocars meanplusmnSD 460plusmn723 430plusmn068 056

length of stay meanplusmnSD 373plusmn254 447plusmn318 0003

Recovery room time meanplusmnSD 8439plusmn2828 8763plusmn2911 0301

HDU admission n () 32 (65) 62 (286) P lt 00001

There is no significant difference in the duration of operation length of stay Number of trocars and Recovery room time between the two groups

LSG was performed successfully in all patients and no conversion to open or documented intraoperative complications in both groups

Result

MO

BMI lt 50 group(21)

SMO

BMI ge 50 group(13)

P-value

Blood transfusion n () 4 (08) 0 (0) 0230

Early leak n () 4 (08) 1 (05) 0515

Late leak n () 7 (14) 2 (09) 0445

Post operative bleeding n () 10 (2) 10 (46) 0057

4

96

MO

With Postoperative complications

no Postoperative complications

6

94

SMO

With Postoperative complications

no Postoperative complications

Conclusion

To sum up therersquos no significant difference in the duration of operation number of trocars and

intra operative complication between SMO and MO The BMI ge50 is not a predictor of higher morbidity during doing laparoscopic sleeve

gastrectomy at King Khalid University Hospital Saudi Arabian experience

Acknowledgment

bull Special thanks to DrFahad Bamehriz who was guiding and supporting us in every step of the research

bull Also we would like to thank MissSara ALhezan from obesity center faculty for their valuable time

Reference

1 Sturm R Hattori A Morbid obesity rates continue to rise rapidly in the United States Int J Obes (Lond) 2013 Jun37(6)889-91

2 Serrano O Tannebaum J Cumella L Choi J Vemulapalli P Scott Melvin W et al Weight loss outcomes and complications from bariatric surgery in the super super obese Surgical Endoscopy 2015

3 Zerrweck C Sepuacutelveda E Maydoacuten H Campos F Spaventa A Pratti V et al Laparoscopic Gastric Bypass vs Sleeve Gastrectomy in the Super Obese Patient Early Outcomes of an Observational Study Obesity Surgery 201324(5)712-717

4 Kushnir L Dunnican W Benedetto B Wang W Dolce C Lopez S et al Is BMI greater than 60 kgm2 a predictor of higher morbidity after laparoscopic Roux-en-Y gastric bypass Surgical Endoscopy 200924(1)94-97

5 Lemanu D Srinivasa S Singh P MacCormick A Ulmer S Morrow J et al Single-stage laparoscopic sleeve gastrectomy safety and efficacy in the super-obese Journal of Surgical Research 2012177(1)49-54

6 Serrano OK1 Tannebaum JE Cumella L Choi J Vemulapalli P Scott Melvin W et al Weight loss outcomes and complications from bariatric surgery in the super super obese Surg Endosc 2015 Aug 25

7 Tagaya N1 Kasama K Kikkawa R Kanahira E Umezawa A Oshiro T et al Experience with laparoscopic sleeve gastrectomy for morbid versus super morbid obesity Obes Surg 2009 Oct19(10)1371-6

8 Zerrweck C1 Sepuacutelveda EM Maydoacuten HG Campos F Spaventa AG Pratti V et al Laparoscopic gastric bypass vs sleeve gastrectomy in the super obese patient early outcomes of anobservational study Obes Surg 2014 May24(5)712-7

9 Eisenberg D1 Bellatorre A Bellatorre N Sleeve gastrectomy as a stand-alone bariatric operation for severe morbid and super obesity JSLS 2013 Jan-Mar17(1)63-7

Result

Out Of 708 patients performing LSG their 217 (31) patients with BMI ge 50 with comparable BMI (583plusmn72 kgm2 for SMO (BMI ge 50) group vs 419 plusmn47 kgm2 for MO (BMI lt 50) group P lt 00001)

MO

N= 490

SMO

N= 217

P-value

Age meanplusmnSD 3346plusmn107 3221plusmn11 0155

Height meanplusmnSD 16plusmn0096 165plusmn0007 0500

Admission weight meanplusmnSD 1141plusmn192 15940plusmn265 P lt 00001

Admission BMI meanplusmnSD 419plusmn47 5827plusmn719 P lt 00001

3700

6360

6300

3640

000 1000 2000 3000 4000 5000 6000 7000

BMI lt 50

BMI equal 50 or more

Female Male

Result

MO

N= 491

SMO

N= 217

P-value

Hypertension n () 67 (136) 36 (166) 0306

Diabetes mellitus n () 68 (138) 29(134) 0863

Dyslipidemia n () 38 (77) 24 (111) 0150

Sleep apnea n () 69 (141) 48 (212) 0017

Infertility n () 6 (12) 2 (09) 0535

1360 1380

770

1410

120

1660

1340

1110

2120

090

000

500

1000

1500

2000

2500

Hypertension Diabetes mellitus Dyslipidemia Sleep apnea Infertility

MO SMO

Result

MO

BMI lt 50 group

SMO

BMI ge 50 group

P-value

Duration of operation meanplusmnSD 9064plusmn383 9274plusmn35 053

Number of trocars meanplusmnSD 460plusmn723 430plusmn068 056

length of stay meanplusmnSD 373plusmn254 447plusmn318 0003

Recovery room time meanplusmnSD 8439plusmn2828 8763plusmn2911 0301

HDU admission n () 32 (65) 62 (286) P lt 00001

There is no significant difference in the duration of operation length of stay Number of trocars and Recovery room time between the two groups

LSG was performed successfully in all patients and no conversion to open or documented intraoperative complications in both groups

Result

MO

BMI lt 50 group(21)

SMO

BMI ge 50 group(13)

P-value

Blood transfusion n () 4 (08) 0 (0) 0230

Early leak n () 4 (08) 1 (05) 0515

Late leak n () 7 (14) 2 (09) 0445

Post operative bleeding n () 10 (2) 10 (46) 0057

4

96

MO

With Postoperative complications

no Postoperative complications

6

94

SMO

With Postoperative complications

no Postoperative complications

Conclusion

To sum up therersquos no significant difference in the duration of operation number of trocars and

intra operative complication between SMO and MO The BMI ge50 is not a predictor of higher morbidity during doing laparoscopic sleeve

gastrectomy at King Khalid University Hospital Saudi Arabian experience

Acknowledgment

bull Special thanks to DrFahad Bamehriz who was guiding and supporting us in every step of the research

bull Also we would like to thank MissSara ALhezan from obesity center faculty for their valuable time

Reference

1 Sturm R Hattori A Morbid obesity rates continue to rise rapidly in the United States Int J Obes (Lond) 2013 Jun37(6)889-91

2 Serrano O Tannebaum J Cumella L Choi J Vemulapalli P Scott Melvin W et al Weight loss outcomes and complications from bariatric surgery in the super super obese Surgical Endoscopy 2015

3 Zerrweck C Sepuacutelveda E Maydoacuten H Campos F Spaventa A Pratti V et al Laparoscopic Gastric Bypass vs Sleeve Gastrectomy in the Super Obese Patient Early Outcomes of an Observational Study Obesity Surgery 201324(5)712-717

4 Kushnir L Dunnican W Benedetto B Wang W Dolce C Lopez S et al Is BMI greater than 60 kgm2 a predictor of higher morbidity after laparoscopic Roux-en-Y gastric bypass Surgical Endoscopy 200924(1)94-97

5 Lemanu D Srinivasa S Singh P MacCormick A Ulmer S Morrow J et al Single-stage laparoscopic sleeve gastrectomy safety and efficacy in the super-obese Journal of Surgical Research 2012177(1)49-54

6 Serrano OK1 Tannebaum JE Cumella L Choi J Vemulapalli P Scott Melvin W et al Weight loss outcomes and complications from bariatric surgery in the super super obese Surg Endosc 2015 Aug 25

7 Tagaya N1 Kasama K Kikkawa R Kanahira E Umezawa A Oshiro T et al Experience with laparoscopic sleeve gastrectomy for morbid versus super morbid obesity Obes Surg 2009 Oct19(10)1371-6

8 Zerrweck C1 Sepuacutelveda EM Maydoacuten HG Campos F Spaventa AG Pratti V et al Laparoscopic gastric bypass vs sleeve gastrectomy in the super obese patient early outcomes of anobservational study Obes Surg 2014 May24(5)712-7

9 Eisenberg D1 Bellatorre A Bellatorre N Sleeve gastrectomy as a stand-alone bariatric operation for severe morbid and super obesity JSLS 2013 Jan-Mar17(1)63-7

Result

MO

N= 491

SMO

N= 217

P-value

Hypertension n () 67 (136) 36 (166) 0306

Diabetes mellitus n () 68 (138) 29(134) 0863

Dyslipidemia n () 38 (77) 24 (111) 0150

Sleep apnea n () 69 (141) 48 (212) 0017

Infertility n () 6 (12) 2 (09) 0535

1360 1380

770

1410

120

1660

1340

1110

2120

090

000

500

1000

1500

2000

2500

Hypertension Diabetes mellitus Dyslipidemia Sleep apnea Infertility

MO SMO

Result

MO

BMI lt 50 group

SMO

BMI ge 50 group

P-value

Duration of operation meanplusmnSD 9064plusmn383 9274plusmn35 053

Number of trocars meanplusmnSD 460plusmn723 430plusmn068 056

length of stay meanplusmnSD 373plusmn254 447plusmn318 0003

Recovery room time meanplusmnSD 8439plusmn2828 8763plusmn2911 0301

HDU admission n () 32 (65) 62 (286) P lt 00001

There is no significant difference in the duration of operation length of stay Number of trocars and Recovery room time between the two groups

LSG was performed successfully in all patients and no conversion to open or documented intraoperative complications in both groups

Result

MO

BMI lt 50 group(21)

SMO

BMI ge 50 group(13)

P-value

Blood transfusion n () 4 (08) 0 (0) 0230

Early leak n () 4 (08) 1 (05) 0515

Late leak n () 7 (14) 2 (09) 0445

Post operative bleeding n () 10 (2) 10 (46) 0057

4

96

MO

With Postoperative complications

no Postoperative complications

6

94

SMO

With Postoperative complications

no Postoperative complications

Conclusion

To sum up therersquos no significant difference in the duration of operation number of trocars and

intra operative complication between SMO and MO The BMI ge50 is not a predictor of higher morbidity during doing laparoscopic sleeve

gastrectomy at King Khalid University Hospital Saudi Arabian experience

Acknowledgment

bull Special thanks to DrFahad Bamehriz who was guiding and supporting us in every step of the research

bull Also we would like to thank MissSara ALhezan from obesity center faculty for their valuable time

Reference

1 Sturm R Hattori A Morbid obesity rates continue to rise rapidly in the United States Int J Obes (Lond) 2013 Jun37(6)889-91

2 Serrano O Tannebaum J Cumella L Choi J Vemulapalli P Scott Melvin W et al Weight loss outcomes and complications from bariatric surgery in the super super obese Surgical Endoscopy 2015

3 Zerrweck C Sepuacutelveda E Maydoacuten H Campos F Spaventa A Pratti V et al Laparoscopic Gastric Bypass vs Sleeve Gastrectomy in the Super Obese Patient Early Outcomes of an Observational Study Obesity Surgery 201324(5)712-717

4 Kushnir L Dunnican W Benedetto B Wang W Dolce C Lopez S et al Is BMI greater than 60 kgm2 a predictor of higher morbidity after laparoscopic Roux-en-Y gastric bypass Surgical Endoscopy 200924(1)94-97

5 Lemanu D Srinivasa S Singh P MacCormick A Ulmer S Morrow J et al Single-stage laparoscopic sleeve gastrectomy safety and efficacy in the super-obese Journal of Surgical Research 2012177(1)49-54

6 Serrano OK1 Tannebaum JE Cumella L Choi J Vemulapalli P Scott Melvin W et al Weight loss outcomes and complications from bariatric surgery in the super super obese Surg Endosc 2015 Aug 25

7 Tagaya N1 Kasama K Kikkawa R Kanahira E Umezawa A Oshiro T et al Experience with laparoscopic sleeve gastrectomy for morbid versus super morbid obesity Obes Surg 2009 Oct19(10)1371-6

8 Zerrweck C1 Sepuacutelveda EM Maydoacuten HG Campos F Spaventa AG Pratti V et al Laparoscopic gastric bypass vs sleeve gastrectomy in the super obese patient early outcomes of anobservational study Obes Surg 2014 May24(5)712-7

9 Eisenberg D1 Bellatorre A Bellatorre N Sleeve gastrectomy as a stand-alone bariatric operation for severe morbid and super obesity JSLS 2013 Jan-Mar17(1)63-7

Result

MO

BMI lt 50 group

SMO

BMI ge 50 group

P-value

Duration of operation meanplusmnSD 9064plusmn383 9274plusmn35 053

Number of trocars meanplusmnSD 460plusmn723 430plusmn068 056

length of stay meanplusmnSD 373plusmn254 447plusmn318 0003

Recovery room time meanplusmnSD 8439plusmn2828 8763plusmn2911 0301

HDU admission n () 32 (65) 62 (286) P lt 00001

There is no significant difference in the duration of operation length of stay Number of trocars and Recovery room time between the two groups

LSG was performed successfully in all patients and no conversion to open or documented intraoperative complications in both groups

Result

MO

BMI lt 50 group(21)

SMO

BMI ge 50 group(13)

P-value

Blood transfusion n () 4 (08) 0 (0) 0230

Early leak n () 4 (08) 1 (05) 0515

Late leak n () 7 (14) 2 (09) 0445

Post operative bleeding n () 10 (2) 10 (46) 0057

4

96

MO

With Postoperative complications

no Postoperative complications

6

94

SMO

With Postoperative complications

no Postoperative complications

Conclusion

To sum up therersquos no significant difference in the duration of operation number of trocars and

intra operative complication between SMO and MO The BMI ge50 is not a predictor of higher morbidity during doing laparoscopic sleeve

gastrectomy at King Khalid University Hospital Saudi Arabian experience

Acknowledgment

bull Special thanks to DrFahad Bamehriz who was guiding and supporting us in every step of the research

bull Also we would like to thank MissSara ALhezan from obesity center faculty for their valuable time

Reference

1 Sturm R Hattori A Morbid obesity rates continue to rise rapidly in the United States Int J Obes (Lond) 2013 Jun37(6)889-91

2 Serrano O Tannebaum J Cumella L Choi J Vemulapalli P Scott Melvin W et al Weight loss outcomes and complications from bariatric surgery in the super super obese Surgical Endoscopy 2015

3 Zerrweck C Sepuacutelveda E Maydoacuten H Campos F Spaventa A Pratti V et al Laparoscopic Gastric Bypass vs Sleeve Gastrectomy in the Super Obese Patient Early Outcomes of an Observational Study Obesity Surgery 201324(5)712-717

4 Kushnir L Dunnican W Benedetto B Wang W Dolce C Lopez S et al Is BMI greater than 60 kgm2 a predictor of higher morbidity after laparoscopic Roux-en-Y gastric bypass Surgical Endoscopy 200924(1)94-97

5 Lemanu D Srinivasa S Singh P MacCormick A Ulmer S Morrow J et al Single-stage laparoscopic sleeve gastrectomy safety and efficacy in the super-obese Journal of Surgical Research 2012177(1)49-54

6 Serrano OK1 Tannebaum JE Cumella L Choi J Vemulapalli P Scott Melvin W et al Weight loss outcomes and complications from bariatric surgery in the super super obese Surg Endosc 2015 Aug 25

7 Tagaya N1 Kasama K Kikkawa R Kanahira E Umezawa A Oshiro T et al Experience with laparoscopic sleeve gastrectomy for morbid versus super morbid obesity Obes Surg 2009 Oct19(10)1371-6

8 Zerrweck C1 Sepuacutelveda EM Maydoacuten HG Campos F Spaventa AG Pratti V et al Laparoscopic gastric bypass vs sleeve gastrectomy in the super obese patient early outcomes of anobservational study Obes Surg 2014 May24(5)712-7

9 Eisenberg D1 Bellatorre A Bellatorre N Sleeve gastrectomy as a stand-alone bariatric operation for severe morbid and super obesity JSLS 2013 Jan-Mar17(1)63-7

Result

MO

BMI lt 50 group(21)

SMO

BMI ge 50 group(13)

P-value

Blood transfusion n () 4 (08) 0 (0) 0230

Early leak n () 4 (08) 1 (05) 0515

Late leak n () 7 (14) 2 (09) 0445

Post operative bleeding n () 10 (2) 10 (46) 0057

4

96

MO

With Postoperative complications

no Postoperative complications

6

94

SMO

With Postoperative complications

no Postoperative complications

Conclusion

To sum up therersquos no significant difference in the duration of operation number of trocars and

intra operative complication between SMO and MO The BMI ge50 is not a predictor of higher morbidity during doing laparoscopic sleeve

gastrectomy at King Khalid University Hospital Saudi Arabian experience

Acknowledgment

bull Special thanks to DrFahad Bamehriz who was guiding and supporting us in every step of the research

bull Also we would like to thank MissSara ALhezan from obesity center faculty for their valuable time

Reference

1 Sturm R Hattori A Morbid obesity rates continue to rise rapidly in the United States Int J Obes (Lond) 2013 Jun37(6)889-91

2 Serrano O Tannebaum J Cumella L Choi J Vemulapalli P Scott Melvin W et al Weight loss outcomes and complications from bariatric surgery in the super super obese Surgical Endoscopy 2015

3 Zerrweck C Sepuacutelveda E Maydoacuten H Campos F Spaventa A Pratti V et al Laparoscopic Gastric Bypass vs Sleeve Gastrectomy in the Super Obese Patient Early Outcomes of an Observational Study Obesity Surgery 201324(5)712-717

4 Kushnir L Dunnican W Benedetto B Wang W Dolce C Lopez S et al Is BMI greater than 60 kgm2 a predictor of higher morbidity after laparoscopic Roux-en-Y gastric bypass Surgical Endoscopy 200924(1)94-97

5 Lemanu D Srinivasa S Singh P MacCormick A Ulmer S Morrow J et al Single-stage laparoscopic sleeve gastrectomy safety and efficacy in the super-obese Journal of Surgical Research 2012177(1)49-54

6 Serrano OK1 Tannebaum JE Cumella L Choi J Vemulapalli P Scott Melvin W et al Weight loss outcomes and complications from bariatric surgery in the super super obese Surg Endosc 2015 Aug 25

7 Tagaya N1 Kasama K Kikkawa R Kanahira E Umezawa A Oshiro T et al Experience with laparoscopic sleeve gastrectomy for morbid versus super morbid obesity Obes Surg 2009 Oct19(10)1371-6

8 Zerrweck C1 Sepuacutelveda EM Maydoacuten HG Campos F Spaventa AG Pratti V et al Laparoscopic gastric bypass vs sleeve gastrectomy in the super obese patient early outcomes of anobservational study Obes Surg 2014 May24(5)712-7

9 Eisenberg D1 Bellatorre A Bellatorre N Sleeve gastrectomy as a stand-alone bariatric operation for severe morbid and super obesity JSLS 2013 Jan-Mar17(1)63-7

Conclusion

To sum up therersquos no significant difference in the duration of operation number of trocars and

intra operative complication between SMO and MO The BMI ge50 is not a predictor of higher morbidity during doing laparoscopic sleeve

gastrectomy at King Khalid University Hospital Saudi Arabian experience

Acknowledgment

bull Special thanks to DrFahad Bamehriz who was guiding and supporting us in every step of the research

bull Also we would like to thank MissSara ALhezan from obesity center faculty for their valuable time

Reference

1 Sturm R Hattori A Morbid obesity rates continue to rise rapidly in the United States Int J Obes (Lond) 2013 Jun37(6)889-91

2 Serrano O Tannebaum J Cumella L Choi J Vemulapalli P Scott Melvin W et al Weight loss outcomes and complications from bariatric surgery in the super super obese Surgical Endoscopy 2015

3 Zerrweck C Sepuacutelveda E Maydoacuten H Campos F Spaventa A Pratti V et al Laparoscopic Gastric Bypass vs Sleeve Gastrectomy in the Super Obese Patient Early Outcomes of an Observational Study Obesity Surgery 201324(5)712-717

4 Kushnir L Dunnican W Benedetto B Wang W Dolce C Lopez S et al Is BMI greater than 60 kgm2 a predictor of higher morbidity after laparoscopic Roux-en-Y gastric bypass Surgical Endoscopy 200924(1)94-97

5 Lemanu D Srinivasa S Singh P MacCormick A Ulmer S Morrow J et al Single-stage laparoscopic sleeve gastrectomy safety and efficacy in the super-obese Journal of Surgical Research 2012177(1)49-54

6 Serrano OK1 Tannebaum JE Cumella L Choi J Vemulapalli P Scott Melvin W et al Weight loss outcomes and complications from bariatric surgery in the super super obese Surg Endosc 2015 Aug 25

7 Tagaya N1 Kasama K Kikkawa R Kanahira E Umezawa A Oshiro T et al Experience with laparoscopic sleeve gastrectomy for morbid versus super morbid obesity Obes Surg 2009 Oct19(10)1371-6

8 Zerrweck C1 Sepuacutelveda EM Maydoacuten HG Campos F Spaventa AG Pratti V et al Laparoscopic gastric bypass vs sleeve gastrectomy in the super obese patient early outcomes of anobservational study Obes Surg 2014 May24(5)712-7

9 Eisenberg D1 Bellatorre A Bellatorre N Sleeve gastrectomy as a stand-alone bariatric operation for severe morbid and super obesity JSLS 2013 Jan-Mar17(1)63-7

Acknowledgment

bull Special thanks to DrFahad Bamehriz who was guiding and supporting us in every step of the research

bull Also we would like to thank MissSara ALhezan from obesity center faculty for their valuable time

Reference

1 Sturm R Hattori A Morbid obesity rates continue to rise rapidly in the United States Int J Obes (Lond) 2013 Jun37(6)889-91

2 Serrano O Tannebaum J Cumella L Choi J Vemulapalli P Scott Melvin W et al Weight loss outcomes and complications from bariatric surgery in the super super obese Surgical Endoscopy 2015

3 Zerrweck C Sepuacutelveda E Maydoacuten H Campos F Spaventa A Pratti V et al Laparoscopic Gastric Bypass vs Sleeve Gastrectomy in the Super Obese Patient Early Outcomes of an Observational Study Obesity Surgery 201324(5)712-717

4 Kushnir L Dunnican W Benedetto B Wang W Dolce C Lopez S et al Is BMI greater than 60 kgm2 a predictor of higher morbidity after laparoscopic Roux-en-Y gastric bypass Surgical Endoscopy 200924(1)94-97

5 Lemanu D Srinivasa S Singh P MacCormick A Ulmer S Morrow J et al Single-stage laparoscopic sleeve gastrectomy safety and efficacy in the super-obese Journal of Surgical Research 2012177(1)49-54

6 Serrano OK1 Tannebaum JE Cumella L Choi J Vemulapalli P Scott Melvin W et al Weight loss outcomes and complications from bariatric surgery in the super super obese Surg Endosc 2015 Aug 25

7 Tagaya N1 Kasama K Kikkawa R Kanahira E Umezawa A Oshiro T et al Experience with laparoscopic sleeve gastrectomy for morbid versus super morbid obesity Obes Surg 2009 Oct19(10)1371-6

8 Zerrweck C1 Sepuacutelveda EM Maydoacuten HG Campos F Spaventa AG Pratti V et al Laparoscopic gastric bypass vs sleeve gastrectomy in the super obese patient early outcomes of anobservational study Obes Surg 2014 May24(5)712-7

9 Eisenberg D1 Bellatorre A Bellatorre N Sleeve gastrectomy as a stand-alone bariatric operation for severe morbid and super obesity JSLS 2013 Jan-Mar17(1)63-7

Reference

1 Sturm R Hattori A Morbid obesity rates continue to rise rapidly in the United States Int J Obes (Lond) 2013 Jun37(6)889-91

2 Serrano O Tannebaum J Cumella L Choi J Vemulapalli P Scott Melvin W et al Weight loss outcomes and complications from bariatric surgery in the super super obese Surgical Endoscopy 2015

3 Zerrweck C Sepuacutelveda E Maydoacuten H Campos F Spaventa A Pratti V et al Laparoscopic Gastric Bypass vs Sleeve Gastrectomy in the Super Obese Patient Early Outcomes of an Observational Study Obesity Surgery 201324(5)712-717

4 Kushnir L Dunnican W Benedetto B Wang W Dolce C Lopez S et al Is BMI greater than 60 kgm2 a predictor of higher morbidity after laparoscopic Roux-en-Y gastric bypass Surgical Endoscopy 200924(1)94-97

5 Lemanu D Srinivasa S Singh P MacCormick A Ulmer S Morrow J et al Single-stage laparoscopic sleeve gastrectomy safety and efficacy in the super-obese Journal of Surgical Research 2012177(1)49-54

6 Serrano OK1 Tannebaum JE Cumella L Choi J Vemulapalli P Scott Melvin W et al Weight loss outcomes and complications from bariatric surgery in the super super obese Surg Endosc 2015 Aug 25

7 Tagaya N1 Kasama K Kikkawa R Kanahira E Umezawa A Oshiro T et al Experience with laparoscopic sleeve gastrectomy for morbid versus super morbid obesity Obes Surg 2009 Oct19(10)1371-6

8 Zerrweck C1 Sepuacutelveda EM Maydoacuten HG Campos F Spaventa AG Pratti V et al Laparoscopic gastric bypass vs sleeve gastrectomy in the super obese patient early outcomes of anobservational study Obes Surg 2014 May24(5)712-7

9 Eisenberg D1 Bellatorre A Bellatorre N Sleeve gastrectomy as a stand-alone bariatric operation for severe morbid and super obesity JSLS 2013 Jan-Mar17(1)63-7

Reference

10 Health Quality Ontario Bariatric surgery an evidence-based analysis Ont Health Technol Assess Ser 2005 5(1) 1ndash148

11 Ahluwalia JS1 Chang PC23 Tai CM45 Tsai CC67 Sun PL89 Huang CK1011 Comparative Study Between Laparoscopic Adjustable Gastric Banded Plication and Sleeve Gastrectomy in Moderate Obesity-2 Year Results Obes Surg 2016 Mar26(3)552-7

12 Park JY1 Kim YJ1 Laparoscopic gastric bypass vs sleeve gastrectomy in obese Korean patients World J Gastroenterol 2015 Nov 2821(44)12612-9

13 Al Falah HM1 AlSalamah SM Abdullah M AlQahtani HH Abbas GS AlSalamah YA An experience of laparoscopic sleeve gastrectomy in obese morbidly obese and super morbid obese patients Saudi Med J 2013 May34(5)503-10

14 Weiner RA1 El-Sayes IA Theodoridou S Weiner SR Scheffel O Early post-operative complications incidence management and impact on length of hospital stay Aretrospective comparison between laparoscopic gastric bypass and sleeve gastrectomy Obes Surg 2013 Dec23(12)2004-12

15 Deitel M Gagner M Erickson AL et al Third international summitcurrent status of sleeve gastrectomy Surg Obes Relat Dis 20117749ndash59

16 Suter M1 Calmes JM Paroz A Romy S Giusti V Results of Roux-en-Y gastric bypass in morbidly obese vs superobese patients similar body weight loss correction of comorbidities and improvement of quality of life Arch Surg 2009 Apr144(4)312-8 discussion 318

17 Livingston EH1 Huerta S Arthur D Lee S De Shields S Heber D Male gender is a predictor of morbidity and age a predictor of mortality for patients undergoing gastric bypasssurgery Ann Surg 2002 Nov236(5)576-82

18 Fernandez Jr J Demaria S Tichansky M Kellum G Wolfe Meador et al Multivariate Analysis of Risk Factors for Death Following Gastric Bypass for Treatment of Morbid Obesity Ann Surg 2004 May 239(5) 698ndash703

Thank you Any questions